I have spent 20 years working in nonprofit think tanks, the last 13 as a resident scholar with the Institute for Policy Innovation in Dallas. I also ran the Washington, D.C.-based Council for Affordable Health Insurance for nearly nine years. While I cover a range of political, economic and policy areas, I specialize in health policy. Prior to joining the think tanks, I taught philosophy. I received all three of my degrees—BBA in economics, masters in divinity and Ph.D. in humanities—from Texas universities. I was an ethicist for a medical school's panel reviewing human experimentation. I'm a member of the U.S. Commission on Civil Rights Texas Advisory Committee. For several years I was a political analyst for the USA Radio Network, and I hold a 6th degree black belt in Tae Kwon Do and still teach.

9/08/2011 @ 1:16PM1,529 views

Romney vs. Perry: The Debate Over Health Care Reform

In the GOP presidential debate at the Reagan Library, former Massachusetts Governor Mitt Romney defended his health care reform legislation—sort of. Texas Governor Rick Perry objected to the Massachusetts mandate requiring people to buy health insurance and defended his own health care record, while challenging the federal government to loosen its strings on programs like Medicaid.

It’s a fundamental clash of visions: Perry wants to enact and expand what’s known as consumer-driven health care options that invest decision-making power in patients and their physicians. Romney, by contrast, passed the most far-reaching, top-down, government-directed health care reform legislation in the nation’s history, until surpassed by ObamaCare.

In his 2008 presidential election campaign, Romney’s staff asked some of the conservative health policy experts to be part of an informal, unpaid health care advisory team. I was one of those invited. At the first of only a couple of meetings, I raised the question whether Romney still backed the individual mandate; none of the invited advisors did.

The staffer who helped Romney pass the legislation explained that he really didn’t support that part of the bill, but he had a Democratic legislature that demanded it—a theme that Romney echoed in the debate. I responded by pointing out that the current House and Senate were both held by Democrats, and it wasn’t terribly reassuring to say, in essence, Democrats made me do it.

Of course, he now defends the mandate as a way to force people to take responsibility for their health care costs. And he tries to tap into conservative support for federalism by claiming that what he did for Massachusetts was right for his state, but not necessarily right for other states.

But no conservative denies Massachusetts has the right to pass the prequel to ObamaCare, just as states have the right to impose a 100 percent state income tax. The issue is whether it’s good policy and whether any conservative would ever support such a plan. And the answer is no, on both counts.

Mandating people buy coverage means the government—through a quasi-government bureaucracy known as an “exchange”—must determine what is “qualified coverage” and which insurers can sell it. Special interest groups impose tremendous pressure to make the coverage very comprehensive, which makes it very expensive—a problem for individuals and employers having to buy the coverage, as well as the state, which is subsidizing low-income people.

In order to control those rising costs, the government looks for ways to impose price controls. As demand and costs rise, but prices can’t, doctors and other health providers and health insurers begin to opt out of the system. That reduces access and competition, and patients complain about limited choices, long waits and the decline of the doctor-patient relationship. Which is where we are in the Bay State, and where we’ll go under ObamaCare.

Defenders of the plan predicted that comprehensive reform would lower health care spending—just as they did when promoting ObamaCare. And yet the Boston-based Beacon Hill Institute points out in “The High Price of Massachusetts Health Care Reform” that total costs—federal, state and private—have increased by $8.6 billion over the program’s first five years.

Supporters claim that Massachusetts has only 2 percent uninsured, the lowest in the country. But that decline is largely because the government is subsidizing so many people. And having all those people insured hasn’t reduced expensive emergency room visits, which are up 7.2 percent, according to Beacon Hill, in part because of access problems.

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They both stink! Why the heck doesn’t anyone ever address the 800 lb. gorilla in the room? The rest of these proposals push the cost problem a little here and a little there, but do nothing to drive costs down. The gorilla actually seems to be a sacred cow. It is the monopolies in healthcare that drive the costs.

Why not start addressing healthcare costs by eliminating the monopolies. No self-respecting conservative supports monopolies. No self-respecting liberal supports monopolies and folks in the middle don’t either. So how do they manage to exist when they are the major drivers of cost in medical care? My guess would be lot’s of money to politicians, who are about the only real supporters of monopolies. They are the ones who pass the laws.

It starts with the insurance companies, their anti-trust exemption and their full use of it. Then there are the hospital groups that are the only game in the region and will dictate pricing for services to the insurance companies. Then there are the medical societies. Over the years they have lost some of their monopoly powers, but they still retain the power to license and discipline their members. How can any equity be obtained in the cost of malpractice insurance when only one side of the problem is addressed. Bad doctors are far too often allowed to continue practicing and harming patients until they get caught in a criminal violation. Bad doctors account for 75-90% of malpractice claims. Why not open that monopoly up to the public and insurance rates may go down.

Isn’t there anyone who thinks costs can be controlled in healthcare without eliminating the major cost drivers, the multiple layers of monopolies? That’s as stupid as thinking we can control costs by reducing government spending. Just because the government says we aren’t paying anymore than X doesn’t mean that the cost will be X or less. It’s no wonder we’re mired in an economic recession that shows no sign of abating. The whole damn country’s been listening to too much stupid BS economics spouted by politicians whose only real knowledge of is what they’ve been told as talking points.

People who don’t see monopolies as the worst possible economic evil need to be sent back one hundred years and dumped on the receiving end. I simply can’t understand how anyone can talk about reducing costs by measures that will have only minimal effect without talking about the major cost driver.

Monopolies, lcr1946? I’m mystified. With respect to health insurance, in most states a person buying his own policy (i.e., not employer provided) can choose from several companies and policies. In the group market, the employer chooses the insurer or, if large enough, simply self-insures. There are lots of doctors and providers to choose from. Granted, there is consolidation in the hospital sector, and that trend has been greatly exacerbated by ObamaCare. But it depends on where you live. If it is in Houston or the Dallas/Fort Worth area, there are several competing hospital systems. Less so in smaller towns, but that’s because there aren’t enough patients to support several systems. There are lots of problems in the U.S. health care system, but monopolies aren’t one of them.